Mandl, Kenneth D
Mandl, Kenneth D is an individual health care provider with primary practice located at 300 Longwood Ave Children'S Hospital Boston, Boston MA 02115-5735. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Mandl, Kenneth D can be contacted via phone (617) 355-6624.Contact Information
Primary practice address
300 Longwood Ave Children'S Hospital Boston
Boston MA 02115-5735
Phone: (617) 355-6624
Fax: (617) 730-0335
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 75410 | Massachusetts |
| Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine | 2080P0204X | 75410 | Massachusetts |
Profile Details
| NPI number | 1396852406 |
|---|---|
| LBN Legal business name | Mandl, Kenneth D |
| Credentials | MD, MPH |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 24th, 2006 |
| Last updated | Aug 16th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1396852406 | NPPES |
| Massachusetts | MEDICAID | 3107180 |
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